Providers' use of health information exchange is on the rise and there is credible, albeit “low-quality,” evidence that HIE can lower healthcare costs, but there's scant proof it has reduced patient deaths or improved other clinical outcomes, according to a recent research report.
The 465-page report, “Health Information Exchange” (PDF) was produced by the Pacific Northwest Evidence-based Practice Center at Oregon Health and Science University, Portland, and was funded by the Agency for Healthcare Research and Quality.
The peer-reviewed work was a synthesis of 136 previously published studies on various aspects of health information exchange, including its use, usability, effectiveness (including its impact on financial and clinical outcomes), sustainability and barriers to implementation.
“Low-quality evidence somewhat supports the value of HIE for reducing duplicative laboratory and radiology test ordering, lowering emergency department costs, reducing hospital admissions (less so for readmissions), improving public health reporting, increasing ambulatory quality of care, and improving disability claims processing,” the report said. “In studies of clinician perceptions of HIE, most respondents attributed positive changes to HIE, such as improvements in coordination, communication, and knowledge about the patient. However, in one study, clinicians reported that the HIE did not save time and may not be worth the cost.”
“The full impact of HIE on clinical outcomes and potential harms is inadequately studied,” the authors wrote. Barriers to HIE use included a “lack of critical mass” of exchange use, “inefficient workflow and poorly designed interface and update features.”
The report found that HIE adoption has increased over time, with 76% of U.S. hospitals exchanging information in 2014, up 85% since 2008, and up 23% since 2013, the report authors concluded.
While HIE usage within hospitals has risen, it remains lower among office-based physicians and miniscule among long-term-care providers, the researchers report.
Measuring the clinical effectiveness of health information exchange is tough, said physician informaticists Dr. William Hersh, chairman of the department of medical informatics and clinical cpidemiology at the OHSU School of Medicine and the report's lead author.
“It's challenging to do research on HIE,” Hersh said. “It's not like a drug or treatment. It's something that facilitates healthcare. But that said, the research that has been done could be more robust.”
The focus of future research should be on “what works best. Is it better to do this kind of HIE or that kind of HIE, which I don't think you can tell from the current studies.”
And outcomes research linked to HIE use may be impossible to measure directly, he said.
“How do you tell when you saved a life when it was a matter of looking things up in an HIE?” Hersh said.
“You may need to come up with surrogate measures, whether they lead to the right things being done,” he said, such as, measuring whether patients were treated in a more timely manner when an HIE was used, or whether patients were more likely to get the appropriate treatment or had better diagnoses made or had them made more quickly.
“We need better research to determine that,” he said.
